Discontinuation of long-term benzodiazepine use by sending a letter to users in family practice: a prospective controlled intervention study

• Published in: Drug and alcohol dependence 2005-04, Vol.78 (1), p.49-56
• Main Authors: Gorgels, Wim J.M.J., Oude Voshaar, Richard C., Mol, Audrey J.J., van de Lisdonk, Eloy H., van Balkom, Anton J.L.M., van den Hoogen, Henk J.M., Mulder, Jan, Breteler, Marinus H.M., Zitman, Frans G.
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adult and adolescent clinical studies; Aged; Aged, 80 and over; Benzodiazepines; Benzodiazepines - administration & dosage; Biological and medical sciences; Correspondence as Topic; Discontinuation letter; Discontinuity; Family practice; Family Practice - methods; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Humans; Intervention; Interventions; Letters; Long term users; Male; Medical sciences; Middle Aged; Minimal intervention strategy; Netherlands; Primary health care; Prospective Studies; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Substance-Related Disorders - epidemiology; Substance-Related Disorders - prevention & control; Substance-Related Disorders - psychology; Time
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2004.09.001

Minimal intervention strategies to decrease long-term benzodiazepine use have not yet been evaluated in large primary care based studies with a blinded control condition and a long follow-up period. The purpose of this study was to assess the effects of a letter with a discontinuation advice sent to long-term benzodiazepine users in family practice followed by an evaluation consultation offer. The experimental group consisted of 2425 long-term benzodiazepine users, 1707 of whom were addressed by a discontinuation letter and an evaluation consultation offer. The control group consisted of 1821 long-term users. Primary endpoints were the number of prescribed daily dosages (PDD) and the percentage of subjects without prescription (quitters). At 21 months a reduction in benzodiazepine prescription of 26% was observed in the experimental group, versus 9% in the control group (PDD difference = 12.5; 95%-ci: 8.2–16.8). In the experimental group 13% and in the control group 5% of the study completers were benzodiazepine prescription free through the full follow-up period (RR = 2.6; 95%-ci: 2.0–3.4). The percentage of quitters at short-term (6 months) was 24% in the experimental group versus 12% in the control group (RR = 2.1; 95%-ci: 1.8–2.4). It is concluded that this intervention strategy steadily reduces long-term benzodiazepine use in family practice.